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Hand, Foot, and Mouth Disease: Causes, Symptoms, and Powerful Prevention Tips (HFMD)

Updated on July 13, 2025
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Hand, foot and mouth disease (HFMD)
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Hand, Foot and Mouth Disease (HFMD) is a common viral infection that primarily affects young children. It is characterized by the appearance of painful sores in the mouth and a rash on the hands, feet, and sometimes other parts of the body. While typically mild, HFMD can be quite uncomfortable for those affected.  

Symptoms of Hand, Foot, and Mouth Disease

Symptoms of Hand, Foot, and Mouth Disease (HFMD) typically develop within 3 to 6 days after initial exposure to the virus—this period is known as the incubation phase. The illness often begins suddenly and follows a recognizable pattern, especially in children under the age of five, though it can affect individuals of any age.

Common symptoms include:

  • Fever: A mild to moderate fever is often the earliest indicator of HFMD. This fever usually ranges from 100°F to 102°F (37.8°C to 38.9°C) and may be accompanied by general feelings of discomfort or irritability, particularly in younger children.

  • Sore throat: The sore throat usually develops early in the illness, making it uncomfortable for the child to eat or drink. This symptom is often a result of inflammation caused by viral activity in the throat and mouth area.

  • Mouth sores: Painful blisters or ulcers inside the mouth are a hallmark of HFMD. These lesions usually appear on the tongue, inner cheeks, gums, and roof of the mouth. Initially, they may resemble small red dots that progress into fluid-filled blisters, eventually rupturing and forming shallow ulcers that can cause significant discomfort, especially during eating or swallowing.

  • Skin rash: One to two days after the onset of fever, a rash typically develops. It most commonly appears on the palms of the hands, soles of the feet, and occasionally on the buttocks, knees, elbows, or genital area. The rash may look like flat red spots or small blisters and may or may not be itchy. In some cases, the blisters can become painful but usually heal without scarring.

 

1128px Hand foot and mouth disease on child feet

 

Causes of Hand, Foot, and Mouth Disease

Hand, Foot, and Mouth Disease (HFMD) is caused by a group of viruses known as enteroviruses, with Coxsackievirus A16 being the most common culprit. In some cases, Enterovirus 71 may also be responsible, particularly in more severe outbreaks. These viruses thrive in the human digestive tract and respiratory system and are highly contagious, especially in settings like daycare centers, schools, and households where young children are in close contact.

The disease spreads through several modes of transmission:

  • Direct contact: The virus can be transmitted through close personal contact with an infected individual. This includes exposure to respiratory secretions such as saliva, nasal mucus, or the fluid from the blisters. Kissing, hugging, or sharing utensils can all facilitate the spread of the virus.

  • Indirect contact: HFMD can also spread when a person touches surfaces or objects contaminated with the virus—such as toys, doorknobs, or changing tables—and then touches their eyes, nose, or mouth. The virus can survive on surfaces for several hours, making indirect transmission a significant risk in public or communal environments.

  • Fecal-oral transmission: A major route of infection, especially among infants and toddlers, is the fecal-oral route. This occurs when the virus from an infected person’s stool contaminates hands, food, or water, and then enters another person’s body through the mouth. Poor hand hygiene after diaper changes is a common contributing factor.

Diagnosis of Hand, Foot, and Mouth Disease

Diagnosis of Hand, Foot, and Mouth Disease (HFMD) is primarily clinical, based on a thorough physical examination and a careful assessment of the child’s symptoms. Hallmark signs such as low-grade fever, sore throat, irritability, reduced appetite, and the distinctive rash and painful blisters—typically found on the palms, soles, buttocks, and inside the mouth—are often sufficient for a confident diagnosis. The symmetrical distribution of the rash and the presence of mouth ulcers are particularly indicative of HFMD and help differentiate it from other childhood illnesses.

Because of the highly recognizable pattern of symptoms, laboratory tests are generally not required in routine cases. However, in situations where symptoms are severe, prolonged, or don’t match the typical presentation—such as when neurological complications are suspected—healthcare providers may order additional tests. These may include:

  • Throat swabs or nasal secretions: To identify the virus in the respiratory tract.

  • Stool samples: Since enteroviruses are shed in the stool, testing can confirm the viral strain.

  • Blister fluid samples: Rarely, fluid from the skin lesions may be tested to detect the virus directly.

Such testing is also more likely during community outbreaks, in hospitalized patients, or when public health tracking is necessary to monitor the spread and severity of the disease—especially in cases linked to Enterovirus 71, which has been associated with more serious complications in some regions.

Accurate and timely diagnosis is essential not just for appropriate symptom management but also to reduce unnecessary use of antibiotics, which are ineffective against viral infections. Additionally, early identification helps prevent transmission in settings where children are in close contact, such as schools, daycare centers, and playgrounds. Parents and caregivers are often advised to monitor for changes in the child’s condition and to seek follow-up care if the illness does not improve within a week or if alarming symptoms such as persistent high fever, vomiting, or signs of dehydration occur.

Treatment of Hand, Foot, and Mouth Disease

There is currently no specific antiviral treatment or vaccine for Hand, Foot, and Mouth Disease (HFMD). Fortunately, the illness is usually mild and self-limiting, with most individuals recovering completely within 7 to 10 days without medical intervention. Treatment primarily aims to alleviate symptoms, keep the child comfortable, and prevent complications such as dehydration.

Supportive care measures include:

  • Pain relief: Over-the-counter medications such as acetaminophen (paracetamol) or ibuprofen can help reduce fever and relieve the discomfort caused by mouth sores, skin rashes, and sore throat. Aspirin should be avoided in children due to the risk of Reye’s syndrome.

  • Sore throat relief: Gargling with warm salt water several times a day can help soothe throat irritation in older children and adults. For younger children, sugar-free popsicles or throat sprays may provide temporary relief. Lozenges may also be helpful for older children who are able to use them safely.

  • Cool drinks and soft foods: Eating can be painful due to mouth ulcers, so it’s recommended to offer cold, bland, or soft foods that are easy to swallow. Ice cream, smoothies, yogurt, mashed potatoes, and soups at lukewarm temperatures can be gentle on sore mouths. Avoid spicy, salty, or acidic foods that may irritate the blisters.

  • Hydration: Keeping the child well-hydrated is critical, especially if they are eating less due to mouth pain. Offer fluids frequently, such as water, milk, or oral rehydration solutions. Watch for signs of dehydration like dry mouth, decreased urination, or lethargy.

  • Rest: Adequate rest supports the immune system and aids in recovery. Children should stay home from school or daycare until their fever subsides and mouth sores heal, helping prevent the spread of the virus.

In most cases, children recover without complications. However, if symptoms worsen—such as a high fever that doesn’t go down, signs of dehydration, seizures, or if the child is unusually sleepy or irritable—medical attention should be sought immediately.

Prevention of Hand, Foot, and Mouth Disease

While there is no vaccine to prevent HFMD, several measures can help reduce the risk of infection:

    • Frequent handwashing: Encourage frequent handwashing with soap and water, especially after changing diapers, using the toilet, and before eating.  
    • Disinfecting surfaces: Regularly disinfect frequently touched surfaces such as toys, doorknobs, and countertops.  
    • Avoiding close contact: Avoid close contact with people who are infected with HFMD.  

 

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